Stercoral perforation

Stercoral perforation is defined as a bowel perforation due to pressure necrosis from a faecal mass (faecaloma1. It is uncommon, but a life-threatening, complication of unresolved faecal impaction and can be a cause of acute abdomen secondary to faecal peritonitis.

It may represent 3.2% of all colonic perforations and 2.2% of randomly selected autopsy examinations 2. It generally occurs in older individuals 8.

The postulated pathogenesis is from a rise in intraluminal pressure which becomes greater than the capillary perfusion pressure within the bowel. This then results in focal ischaemia, necrosis, ulceration, and ultimately perforation 1-2.

Location

It typically involves the recto-sigmoid colon on the antimesenteric side in ~90 % of cases 7.

Associations

Conditions causing chronic constipation:

  • NSAID use: possible 7-8
  • opioid/narcotic use 3
CT

A universal component in a stercoral perforation is the formation of a faecaloma which is a localised hard, inspissated, or calcified faecal mass, usually of a diameter equal to or greater than the colonic lumen (due to the lowest blood supply and narrowest diameter). 

There is evidence of extraluminal air +/- extruding faecal content. The site of perforation usually involves the antimesenteric border of the colon.

They can be life threatening with mortality rates ranging between 30-55% 8

Stercoral perforations are almost always free and open, although to some extent plugged by a faecaloma, hence unlikely to resolve spontaneously with conservative management.

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Article Information

rID: 18483
Tag: cases
Synonyms or Alternate Spellings:
  • Stercoral perforations
  • Stercoral colitis with perforation
  • Stercoral ulceration

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